=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316787351
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BEACON CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2024
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 WYNDHURST AVE STE 245C
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21210-2436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-228-3458
-----------------------------------------------------
Fax | 443-292-6938
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 WYNDHURST AVE STE 245C
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21210-2436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-228-3458
-----------------------------------------------------
Fax | 443-292-6938
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ CEO
-----------------------------------------------------
Name | MS. LUBNA NABULSI
-----------------------------------------------------
Credential | MS CCC SLP
-----------------------------------------------------
Telephone | 443-228-3458
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------